Provider Demographics
NPI:1346437795
Name:WELLNESS 1ST CHIROPRACTIC LTD
Entity Type:Organization
Organization Name:WELLNESS 1ST CHIROPRACTIC LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:TODD
Authorized Official - Middle Name:
Authorized Official - Last Name:MCGILLICK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:507-237-2459
Mailing Address - Street 1:311 5TH ST
Mailing Address - Street 2:
Mailing Address - City:GAYLORD
Mailing Address - State:MN
Mailing Address - Zip Code:55334-4412
Mailing Address - Country:US
Mailing Address - Phone:507-237-2459
Mailing Address - Fax:507-237-5321
Practice Address - Street 1:311 5TH ST
Practice Address - Street 2:
Practice Address - City:GAYLORD
Practice Address - State:MN
Practice Address - Zip Code:55334-4412
Practice Address - Country:US
Practice Address - Phone:507-237-2459
Practice Address - Fax:507-237-5321
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-01
Last Update Date:2012-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN555S0WEOtherBCBS
MN272228300Medicaid
MN272228300Medicaid